Outcomes and Considerations in Septal Perforation Repair: A 74-Case Review.

[BACKGROUND] Septal perforation repair is variably successful, and its impact on nasal breathing remains underexplored.

[OBJECTIVE] To evaluate the effectiveness of bipedicled mucosal advancement flap repair in septal perforation surgery, using closure rates and patient-reported breathing outcomes.

[METHODS] A retrospective review was conducted on patients who underwent septal perforation repair using bipedicled mucosal flaps between 2014 and 2023. Closure rates and Nasal Obstruction Symptom Evaluation scores were analyzed using multivariable logistic and linear regression to assess associations with perforation size, flap type, etiology, age, and gender.

[RESULTS] Seventy-four patients were included (63% female; mean age = 43.3 years). Most perforations were due to prior nasal surgery (42%). Repairs were performed via external rhinoplasty with cadaveric dermis interposition in 97% of cases. Mean follow-up was 7.5 months. Closure was successful in 95% of patients. Postoperative NOSE scores improved in 78% of patients (mean improvement = 29 points, < 0.001), with 67% exceeding the minimally clinically important difference of 14 points.

[CONCLUSIONS] Bipedicled mucosal advancement flap repair for septal perforation is associated with a high rate of closure and significant improvement in nasal breathing.